Provider Demographics
NPI:1437491966
Name:WHALEN, KATRINA MANJA (ACNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:KATRINA
Middle Name:MANJA
Last Name:WHALEN
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 38TH PL
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3105
Mailing Address - Country:US
Mailing Address - Phone:818-261-9592
Mailing Address - Fax:
Practice Address - Street 1:127 38TH PL
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-3105
Practice Address - Country:US
Practice Address - Phone:818-261-9592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22279363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care